The Third National Conference on
Quality Health Care for Culturally Diverse Populations:
Advancing Effective Health Care through Systems Development, Data, and Measurement

October 2 - 4, 2002, Chicago, IL
Westin Chicago River North Hotel

Session A-7: Improving physician-patient partnership through computerized skills training

Participatory decision-making and other patient-centered communication behaviors have been related to higher levels of patient satisfaction, greater patient adherence, and better health outcomes. Yet, ethnic minority patients report less partnership with physicians, except when they are in race or ethnic-concordant relationships. The first part of this workshop will be a presentation of research findings on communication behaviors indicative of patient-physician partnership in primary care visits of African-American and white patients with African-American and white physicians. Measures of patient-centeredness, derived from content coding of audio taped primary care visits, as well as patient reports of physicians' participatory decision-making style, will be discussed. Differences in communication between race-concordant and race-discordant patient-physician pairs from actual primary care encounters will be presented, and the potential relevance of using communication patterns observed in race-concordant relationships to design cultural competence training programs will be discussed.

The second part of the workshop will include the demonstration of a communication skills training program that is being tested in a randomized controlled trial to improve patient adherence to recommended therapies for hypertension. The intervention targets urban ethnic minorities and persons living in poverty. The training program is based on models previously shown to be effective in improving physicians' patient-centered interviewing skills and patient outcomes, particularly patient commitment to the therapeutic regimen and adherence to medical recommendations, development of a strong patient-physician partnership, both patient and physician satisfaction with the medical encounter, and improved health and quality of life outcomes. This continuing medical education (CME) program for practicing primary care physicians is comprised of an interactive CD-ROM with a variety of features and is designed for convenience and ease of administration.

First, the CD will present a video of a fully coded [using the Roter Interaction Analysis System (RIAS)] expert conducted interview with an African-American simulated patient. The simulated patient will be scripted to present typical adherence problems and common culturally specific beliefs, expectations, and barriers related to adherence with hypertension therapy. The purpose of the expert interview is to model patient-centered skills and culturally sensitive communication approaches to specific adherence-related challenges addressed in the CME. The RIAS coding allows the learner to navigate the interview in an efficient manner and quickly review examples of specific skills. Second, a personal, fully RIAS analyzed video of a physician learner interviewing the simulated patient (the same patient interviewed by the expert physician) will also be presented on the interactive CD-ROM. Workshop presenters will demonstrate how individualized feedback to each physician on his or her interview through the structured, RIAS-based interactive format is used to highlight the physician's use, or missed opportunities for use, of communication skills identified as important for increasing ethnic minority patient adherence and involvement in care. These elements will have been be modeled in the expert interview.

Proficiency in various elements of the communication process can be measured using the RIAS software. Measurement of proficiencies in adherence-related communication, as well as patient-centered interviewing, verbal dominance, global affect, and other audiotape measures associated with ethnic minority patient satisfaction and ratings of participatory decision-making will be used as process of care indicators of quality and cultural competence.

Workshop participants will have an opportunity to try the software program and will be encouraged to give feedback to the presenters on its potential usefulness and adaptability for teaching culturally sensitive communication behaviors to increase health provider partnership with ethnically and culturally diverse patients.

Dr. Lisa Cooper, Associate Professor of Medicine at Johns Hopkins University, School of Medicine, is a general internist, health services researcher, and medical educator whose research program focuses on patient involvement in medical decision-making and access to health care for African Americans, particularly as they relate to treatment of common problems, such as depression and hypertension, in primary care settings. Her recent work has identified patient-physician communication as an important contributor to racial and ethnic disparities in health care. Dr. Cooper is also involved in the development and implementation of a new curriculum in cultural diversity and the patient-physician relationship for internal medicine residents at Johns Hopkins Bayview Medical Center.

Lisa A. Cooper, MD, MPH
Associate Professor of Medicine and Health Policy & Management
Johns Hopkins University
Welch Center for Prevention, Epidemiology, & Clinical Research
2024 East Monument Street, Suite 2-500
Baltimore, MD 21205-2223
Phone: (410) 614-3659
Fax: (410) 614-0588
E-mail: lisa.cooper@jhmi.edu

Dr. Debra Roter, Professor of Health Policy & Management at Johns Hopkins Bloomberg School of Public Health, is a behavioral scientist and public health researcher who has conducted over 20 original studies of doctor-patient communication, authored over 100 articles, and co-authored two books on the subject. Work relevant to the current workshop falls within the following broad areas: a) descriptive studies of patient-physician communication, including the communication dynamics associated with health promotion and medication-taking; b) intervention studies addressing patient education and activation efforts, as well as physician training in communication skills; and c) targeted communication studies of minority patients and their white and minority physicians.

Debra L. Roter, DrPH
Professor of Health Policy & Management
Johns Hopkins Bloomberg School of Public Health

Susan M. Larson, MS
Project Coordinator
Johns Hopkins Bloomberg School of Public Health

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